Dental Implant at site #18 spinning at time of placement: Will it integrate?

Sure Primary stability is only important if loading immediately . We have shown implants with no primary and no bone to implant contact , fully integrated in 10 weeks with higher Osstell readings at that time than adjacent implants screwed into normal host bone . Will be showing this and more about True Bone Regeneration at the ICOI world congress in NYC on the 16-17 August ...Regards

It may be ok to remove the implant debrief and place a 5X10 and get decent stability. Even finger tight would be ok.

Where possible, take the next to last drill and go deeper 1-2 mm apically. Very often you can get apical initial stability. Then use a cover screw and get primary closure. Alternatively, if you cannot go deeper apically because of the IAN, use a cortical cancellous graft material and layer the walls of the osteotomy. Then reseat implant to same depth wedging between the graft and implant body.

Most likely wont integrate but give it a month and take a radiograph and see how the interface looks

There is a lot of very good advise given in this situation....all from very well respected experts.....however, if I can add something, I will say that there is a good chance that this situation will work out well....you have not put this implant into function, it is well protected from occlusal forces....so if you leave it alone for four months, then uncover it, …..I believe it will work just fine....please post this case when you uncover it....and at the next implant meeting, you are obligated to buy each one of the contributors to this post, an alcoholic beverage....

Usually those work out will if just a spin with no lateral movement. It should integrate. In those cases, I usually will NOT put a healing abutment on....letting it integrate sub gingivally is best. No potential for trauma to the implant Neil Zachs Periodontist, Scottsdale AZ

Probably it will be fine. Spinning is better than wobbling. As far as the healing abutment as opposed to cover screw let’s not forget the Straumann tissue level system with a 1.8-2.8mm trans mucosal portion. I have placed hundreds of these, as have many others, with poor primary stability and they do fine. In the absence of early loading I believe primary stability is just a feel good factor. Don’t sweat it!!

Please note if you have a hole in bone undisturb full of blood , and in infected and no health issues it will be filled with bone. It means the implant even if it doesn't have initial stability it will integrate and become usaable but after litt longer time than your stander time of indigestion. Please don't disturb the implant. Good luck for your case Dr. Ali DDS,MS . Prosthodontist

I would remove the healing abutment and place a cover screw instead. Many great suggestions all through this post. The implant will heal just fine. The healing abutment could put the implant in function with bolus of food in that area. Thank you for sharing

Placing a wooden wedge may help stability. A toothpick would work.

Disclaimer : not responsible for my own poor sense of humor.

Hi Dr, I'm an Implant Direct Rep. Nice placement of implant. Looks like a Replant Tri-Lobe? First thing you can try, is to always use sharp drills and do not overdrill the site, use a pumping motion with lots of water. Also, when driving the implant don't keep spinning the implant as to thread the bone. I've seen that done before. If you suspect the bone to be softer, stop one drill ahead or if going final dense bone protocol, only go halfway (4mm) in this case, so to get good primary stability apical. I like Dr Flanagan's idea of putting in a longer implant if you can. he has placed thousands of implants and gives great advice. If you want to try it, we do have a more aggressive threaded Tri-lobe implant called ReActive. Same drivers, different drill. Lastly...i think it might be fine. If patient follows directions and doesn't disrupt it too much, it might take. Good luck, and keep us posted!

Leave it for 6 months and advise the patient it has a risk. Expose in 6 and if you’re lucky it will be solid. If not remove it and replce in 6 weeks. If it’s not integrating it may develop inflammation and pain. In which Case remove it early.

Back in '89 when I started placing Integral smooth cylinders, the dog research at the time said that the cylinders integrated even if loose.

I have put in many implants that spin and they did fine. Lots of good answers here. Always be on the look out to go 2mm deeper in this region due to risk of injury to the I.A.N. For future reference don't ever take the osteotomy to full bore (width and depth) even in dense bone. I have seen too many dentists do this and overprep when they don't have an implant handy to go wider. Think about any drilling with self tap.

Put cover screw and allow it to heal. I my humble opinion it will integrate

I actually read the original post and realize that the healing abutment can not be removed without removing the implant so placing a cover screw is not an option. Just leave it as is and it will most likely be fine.

Just remove healing abutment and put a cover screw to avoid pressure, micro movement can make it fail. Repost this in 3-4 months

Thank you everyone for the feedback and recommendations. It is greatly appreciated. I will let you know how this case turns out.

It happened to me today , on #19. Not the first time , but definitely better on mandíbulas bone instead of maxillary . I just put healing screw and cover it up . Will check in 4-6 months , but I expect a good outcome .

As someone who has posted on this forum multiple times I think it would be extremely beneficial if people would actually read the original post before volunteering their opinions. The author of this post clearly stated that he was unable to remove the healing abutment due to the lack of stability yet multiple people recommended removal of the healing abutment and placement of the cover screw. The individual was seeking case specific advice and instead recieved multiple, non pertinent, "Mr. Obvious" recommendations. I sympathize since I have had many comments to my posts of equal non relevance which is why I choose other avenues of sharing information. Pleas do everyone a favor and read the post completely prior to giving meaningless information.

That happened to me once and it worked out fine. I wasn't going to post this but I wanted to get in on the beverage Dr Rudick was talking about.

Happens to all of us. Keep patient informed. As long as we have vascular bone, we should be ok. Should have opted for the healing screw. I usually follow up in a month to ensure implant is integrating and then follow up 3 more months after that. Should be fine. I usually keep a few Adin implants for cases like this. Their implants don’t taper at the apex and the threads are pretty wide offering more stability.

That implant may very well integrate. Keep in mind that it will likely lose more bone during the first weeks of healing. Most practitioners would place a cover screw and allow an extra month or so of time for integration to take place. Here's a scenario to consider: you wait 4 to 5 months for healing and uncover the implant. Upon cover screw removal the implant is still spinning. You remove the fixture, and re-prep the site. If you are lucky, and there's still enough circumferential bone to place another implant, your patient will be waiting at least another three months for the second implant to integrate. If you are not lucky, you may have to graft the site and wait three to five months for the site to mature before placing another implant. So you wait and place the second implant and wait another three months for healing. You have now waited ten months to restore an implant that should have taken three months. Keep in mind that there is an unhappy patient attached to the implant. Who's going to pay for the graft and the extra chair time? BTW- your decision to single stage the procedure with a healing abutment of wider dimension than the restorative platform (without profiling) possibly pulled the fixture out of the osteotomy slightly resulting in the spinner in the first place. Just some food for thought.

All Bicon Implants are "spinners " , just a thought